Clark A. Rosen, C. Blake Simpson Operative Techniques in Laryngology

Transcription

1 Clark A. Rosen, C. Blake Simpson Operative Techniques in Laryngology

2 Clark A. Rosen C. Blake Simpson Operative Techniques in Laryngology Forewords by Hans von Leden and Robert H. Ossoff With 390 Figures and 11 Tables 123

3 Clark A. Rosen, M.D. University of Pittsburgh Voice Center UPMC Mercy Hospital 1400 Locust Street, 2100 Bldg D Pittsburgh, PA 15219, rosenca@upmc.edu C. Blake Simpson, M.D. The University of Texas Health Science Center Department of Otolaryngology 7703 Floyd Curl Drive MC-7777 San Antonio, TX , simpsonc@uthscsa.edu ISBN e-isbn Library of Congress Control Number: Springer-Verlag Berlin Heidelberg This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer Verlag. Violations are liable to prosecution under the German Copyright Law. The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product liability: The publishers cannot guarantee the accuracy of any information about dosage and application contained in this book. In every individual case the user must check such information by consulting the relevant literature. Cover design: estudio Calamar, Spain Production: le-tex publishing services ohg, Leipzig Printed on acid-free paper springer.com

4 Dedication I have had the incredible good fortune to be blessed with supportive family, teachers, and friends. It is imperative that I recognize the huge impact of some of these individuals on my personal and professional development and growth. I would like to dedicate this book to my parents, Paul Jack Rosen, M.D., and Shirley Maureen Orr Rosen, who worked tirelessly to provide the optimal growth environment for me and instill in me the best possible work ethic. Over my many years of education, I have had many wonderful teachers. However, one has had the greatest impact, not only on my knowledge base, but also on my approach to learning, teaching, and academic life. I would like to thank Jamie Cohen, M.D., Ph.D., for being an outstanding role model, mentor, and friend. Eugene N. Myers, M.D. has been vital to me from a professional and career development perspective, for providing me the opportunity to achieve my dreams and goals. Without his support, this book would not have been possible. I would like to acknowledge the primal role of Blake Simpson, M.D., in the development of this book from concept to completion. I have grown as a laryngologist due to our mind meld of laryngologic experience and philosophy while writing this book together. I am indebted to the wonderful group of teachers and colleagues with whom I have had the pleasure and privilege to work: Gayle Woodson, M.D.; Thomas Murry, Ph.D.; Robert Buckmire, M.D.; Lori Lombard, Ph.D.; and Jackie Gartner- Schmidt, Ph.D. I would like to acknowledge the importance of my Fellows and OR staff, without whom many of the concepts in this book would not exist: AT, TK, PK, MJB, AF, TC, SR, SO, NS, CP, MB, Icarus, and MLL. Lastly and most importantly, I dedicate this book to Monica Anne Linde, without whose support, energy and love, none of my professional success would have been possible. Sincerely and with deepest gratitude, Clark A. Rosen M.D. Pittsburgh, Pennsylvania March 2008

5 Dedication This work is dedicated to my wife, Cristina, and my twin daughters, Juliana and Audrey. I am eternally grateful for all the love and support you have given me. C. Blake Simpson, M.D. San Antonio, Texas March 2008

6 Foreword In this age of communication, the care of the human voice and the vocal organ has assumed greater and greater importance. The maintenance of good vocal health and the treatment of the diseased larynx are essential for all members of society from heads of state to the receptionist with the golden voice on the telephone. The necessity for the restoration of pathologic changes in the larynx has resulted in the application of numerous operative techniques, which may bewilder the clinician. There is a real need for a comprehensive educational resource like Operative Techniques in Laryngology. The two authors of this textbook, Clark A. Rosen and C. Blake Simpson, both leading scholars and experienced surgeons at major medical centers, have created a superb treatise, which expertly details the surgical care of different laryngeal pathologies. The introductory chapters call attention to the current methods of clinical evaluation for laryngeal disorders, including videostroboscopy and flexible laryngoscopy, as well as the medical treatment of patients with vocal problems. The indicated preoperative measures are discussed in detail, and the importance of anesthesia and airway management during surgical procedures within the larynx are stressed. Subsequent chapters advance the reader from the fundamental principals of laryngeal surgery to such major surgical techniques as phonomicrosurgery, laser surgery, vocal fold augmentation, and surgery of the laryngeal framework. In successive chapters, each pathologic entity is presented in detail, including the etiology, history, vocal quality, physical examination, surgical intervention, postoperative care, and potential complications. Specific microsurgical procedures are recommended for all common benign lesions and for localized neoplasms of the vocal folds. The use of lasers is described for stenosis of the vocal folds and circumscribed malignant lesions. The chapters on vocal fold augmentation include precise information on injection techniques via microlaryngoscopy, as well as peroral and percutaneous approaches. Specific chapters are devoted to the principles of operative care for laryngeal framework surgery. These procedures range medialization laryngoplasty or arytenoid adduction to problems more complex such as cricothyroid subluxation, laryngeal fractures, sulcus vocalis, and stenosis of the larynx and trachea. The reader will be impressed with the clarity of the presentations, which is enhanced by the use of systematic headings, and by the precision and the rich color of the illustrations within each chapter. An abundance of carefully selected references enables the prospective surgeon to pursue further detailed information from various experts as desired. It is apparent that the authors and the publisher have combined their expertise to present an outstanding educational and inspirational textbook for both the clinical otorhinolaryngologist as well as the experienced laryngeal surgeon. I shall cherish my own copy of this exciting edition. Hans von Leden, M.D., Sc.D. Professor Emeritus University of Southern California Los Angeles, California February 2008

7 Foreword The subspecialty of laryngology has gone through a tremendous period of growth and maturation during the past 20 years. Fellowships dedicated to advanced training in laryngology, neurolaryngology, and voice care are now available at several academic health centers and private practices. Furthermore, it is now very common to find at least one fellowship-trained laryngologist on the full-time faculty of many of our resident education programs in otolaryngology head and neck surgery in the United States and Canada. The quality of resident education, patient care, and laryngology-related research has improved because of the advances in this subspecialty promoted by this growing critical mass of individuals who have completed fellowships in laryngology and voice care after their formal residency training in otolaryngology. Now, the cycle has come full circle, with several of the earlier fellowship-trained laryngologists directing laryngology fellowship training programs of their own. Drs. Blake Simpson and Clark Rosen are excellent examples of this training model. Blake spent a year at Vanderbilt in fellowship with me and my colleagues, and Clark spent a year of fellowship training at the University of Tennessee with Dr. Gayle Woodson. Now, both Blake and Clark direct fellowship training programs at their respective institutions. Operative Techniques in Laryngology fills a real void in the field of laryngology and voice care. Drs. Simpson and Rosen present us with a surgical atlas dedicated to and highlighting modern techniques for microlaryngeal surgery and laryngeal framework surgery. They have selected an outstanding group of experts in the field to whose contributions include not only the step-by-step surgical approach to the many problems covered in the atlas, but also addressing the important medical information associated with the various conditions requiring the surgical procedures highlighted in this book. The quality of the illustrations are excellent, and the reader will feel very confident using this atlas as a primary reference for managing appropriate cases in the operating theatre. This atlas represents a major contribution to our laryngology literature, and it should find its way to the office of all laryngologists, laryngology fellows, resident education program libraries, and many community-based otolaryngologist head and neck surgeons who perform a moderated volume of laryngeal surgery in their practices. I am very proud of Blake and Clark for realizing the vision of the growing need for an atlas of surgical techniques in laryngology. I am honored to have had the opportunity to serve as Blake s fellowship mentor and to have had Clark spend a visiting fellow week at Vanderbilt during his fellowship year with Dr. Woodson. I am further honored to be asked by Blake and Clark to write this foreword to their excellent and very important book. Robert H. Ossoff, D.M.D., M.D. Guy M. Maness Professor and Chairman Department of Otolaryngology Vanderbilt University Medical Center Nashville, Tennessee March 2008

8 Preface The field of laryngeal surgery for voice and airway pathologic conditions has dramatically changed over the last 20 years, and the impetus for this book was to reflect these major paradigm shifts, and bring together in one place essential information on the rapidly growing and changing field of laryngeal surgery. The book was written to provide the laryngeal surgeon with: (1) essential background information in voice disorders, (2) step-by-step surgical information for laryngeal surgery, and (3) key pearls and pitfalls about indications, surgical steps, and postoperative management of laryngeal surgeries. The book provides essential background information of which any laryngeal surgeon must have mastery. We feel strongly that a true surgeon is a physician first, and must always approach each patient in a holistic manner, and thus understand the essential anatomy and pathology of voice disorders, as well as the nonsurgical treatment modalities. This supports the concept of vocal medicine, not just vocal surgery. Once surgery has been chosen as a treatment modality, the surgeon must carefully consider timing, planning, anesthesia, and airway considerations. These important issues are reviewed in Chaps. 8 and 9. The book encompasses a wide range of laryngeal procedures, and it has been organized around the broad categories of phonomicrosurgery and laryngeal framework surgery. Within phonomicrosurgery, detailed information is provided regarding surgery for benign and malignant vocal fold lesions, vocal fold augmentation, and laser laryngeal surgery. The laryngeal framework surgery sections include essential chapters on open treatment for unilateral vocal fold paralysis, bilateral vocal fold paralysis, laryngeal trauma, airway stenosis (glottic, subglottic and tracheal), and vocal fold scar/sulcus vocalis. All the chapters have been designed to allow the reader to understand indications, contraindications, equipment required, step-by-step aspects of the procedure, perioperative care, and management of complications. In almost every chapter, one will find important insights or pearls that, until now, have only been taught verbally by mentor to student. We feel that this book will become essential reading for all students of laryngology, and general otolaryngologists performing laryngeal surgery. We have written each chapter of this book; however, for selected chapters, we have been honored to have leaders in our field with whom we collaborated. We would like to thank all of these truly gifted surgeons for sharing their knowledge and expertise. This surgical atlas is richly illustrated with detailed, colorful artwork as well as essential photographic documentation. This book would not have been possible without the hard work and phenomenal talent of the medical illustration team at the University of Texas Health Science Center, San Antonio. We would like to personally thank these gifted and insightful individuals: David Baker, David Aten, and Chris McKee. In closing, we feel that this book brings together a wide variety of new and exciting surgical procedures involving the larynx and upper airway. We would like to thank our supporting staff of Diane Keane and Veronica Aleman, as well as Springer for valuable support from their staff, including Marion M. Philipp and Irmela Bohn. Clark A. Rosen, M.D. C. Blake Simpson, M.D.

9 Acknowledgements The authors wish to thank the following individuals for their important contributions to the book: Kristin J. Otto, M.D., Chap. 1 Phillip Song, M.D., Chap. 2 Scott M. Green, Chap. 13 Paolo Pontez, M.D., Chap. 23 Robert Eller, M.D., Chap. 25 J. Michael King, M.D., Chap. 34 S. Carter Wright, Jr., M.D., Chap. 39 Each one of these individuals contributed a portion of the chapter s contents or supplied the initial draft prior to editing. The authors would like to thank the superb team of medical illustrators at the University of Texas Health Science Center, San Antonio: David Baker David Aten Chris McKee These individuals worked closely with the authors over a fouryear period during the writing of this book. The illustrators went the extra mile, studying cadaveric specimens, attending surgical procedures, and reviewing surgical photos from multiple perspectives. Their mastery of laryngeal anatomy and the surgical perspectives of laryngeal surgery are without peer. Their efforts ultimately resulted in, we believe, the highest quality laryngeal surgical illustrations to date. The authors wish to express thanks to the following companies for their financial support in the making of this book: Olympus Surgical Medtronic ENT Kay Pentax Karl Storz Endoscopy America Salary support for the medical illustrators was significantly funded though generous donations from these corporations. Without their support, this book would not have been possible.

10 Contents Part A Clinical Evaluation of Laryngeal Disorders 1 Anatomy and Physiology of the Larynx Anatomy Laryngeal Cartilages Thyroid Cricoid Arytenoid Accessory Cartilages: Cuneiform and Corniculate Epiglottis Laryngeal Joints Cricothyroid Joint Cricoarytenoid Joint Laryngeal Musculature Intrinsic Laryngeal Muscles Extrinsic Laryngeal Muscles Fibroelastic Tissue of the Larynx Quadrangular Membrane Conus Elasticus Microanatomy of the Vocal Fold Vasculature Innervation Physiology Major Laryngeal Functions: Lower Airway Protection, Respiration, and Phonation Phonation Key Points Selected Bibliography Principles of Clinical Evaluation for Voice Disorders Fundamental and Related Chapters Introduction Gathering a Patient History History of Present Illness Past Medical History Past Surgical History Social History Occupational History Listening to the Voice Perceptual Analysis Quality-of-Life Questionnaires Professional Speaking/Singing Voice Key Points Selected Bibliography Videostroboscopy and Dynamic Voice Evaluation with Flexible Laryngoscopy Fundamental and Related Chapters Introduction Surgical Indications and Contraindications Dynamic Voice Assessment with Flexible Laryngoscopy Nasopharynx Base of Tongue Larynx (Global) Vocal Fold (Focal) Recording of Laryngeal Examination Key Points Selected Bibliography Pathological Conditions of the Vocal Fold Fundamental and Related Chapters Introduction Epithelial Pathology of the Vocal Folds Recurrent Respiratory Papillomatosis of the Larynx Leukoplakia of the Vocal Fold Dysplasia Carcinoma in Situ of the Vocal Folds Carcinoma of the Vocal Fold Benign Diseases of the Vocal Fold Lamina Propria Overview of Midmembranous Vocal Fold Lesions Approach to Midmembranous Vocal Fold Lesions Vocal Fold Nodules Vocal Fold Cyst (Subepithelial) Vocal Fold Cyst (Ligament) Vocal Fold Polyp Fibrous Mass (Subepithelial) Fibrous Mass (Ligament) Reactive Lesion Miscellaneous Disorders of the Vocal Fold Polypoid Corditis (Reinke s Edema) Vocal Fold Granuloma Rheumatologic Lesions of the Vocal Folds Vascular Lesions of the Vocal Folds Vocal Fold Scar and Sulcus Vocalis Key Points Selected Bibliography

11 XVIII Contents 5 Glottic Insufficiency: Vocal Fold Paralysis, Paresis, and Atrophy Introduction Unilateral Vocal Fold Paralysis Etiology Surgical Indications and Contraindications Vocal Quality and Swallowing Unilateral Vocal Fold Paralysis: Physical Examination General Laryngeal Unilateral Vocal Fold Paralysis: Workup Serology Imaging Studies Unilateral Vocal Fold Paralysis: Treatment Unilateral/Bilateral Vocal Fold Paresis Etiology History Physical Examination Diagnostic Workup Treatment Presbylaryngis/Age-Related Changes in the Larynx General Considerations Etiology, History, and Physical Findings Workup Key Points Selected Bibliography Glottic and Subglottic Stenosis: Evaluation and Surgical Planning Fundamental and Related Chapters Introduction Etiology of Glottic and Subglottic (Laryngotracheal) Narrowing Common Clinical Conditions and Associated Risk Factors Glottic and Subglottic Stenosis: History Symptoms/Time Course Medical Comorbidities Glottic and Subglottic Stenosis: Physical Examination Local Anesthesia Techniques for Examination Documentation of Examination Flexible Laryngoscopy/Tracheoscopy Protocol Additional Studies for the Evaluation of Glottic/Subglottic Stenosis Voice Evaluation (VHI-10, Audio Recording) Air-Flow Measures Radiographic Studies Laboratory Testing Glottic and Subglottic Stenosis: Surgical Planning Corrective Surgical Procedures for Glottic/ Subglottic Stenosis Criteria for Endoscopic Treatment for Subglottic Stenosis Criteria for T-Tube Stenting for Subglottic Stenosis Criteria for External Treatment of Glottic/ Subglottic Stenosis Key Points Selected Bibliography Nonsurgical Treatment of Voice Disorders Fundamental and Related Chapters Introduction Surgical Indications and Contraindications Vocal Fold Granuloma Infectious and Inflammatory Disorders Neurologic Disorders Spasmodic Dysphonia Essential Tremor Parkinson s Disease Muscle Tension Dysphonia Paradoxical Vocal Fold Motion Disorder Postviral Vagal Neuropathy Allergy and Voice Disorders Medications and Their Effects on Voice Vocal Hygiene Role of the Speech Language Pathologist in Voice Therapy Key Points Selected Bibliography Timing, Planning, and Decision Making in Phonosurgery Fundamental and Related Chapters Key Components to Successful Care of Patients with Voice Disorders Surgical Indications and Contraindications Timing of Phonomicrosurgery Preoperative Considerations for Phonomicrosurgery Decision Making in Phonosurgery Informed Consent Regarding Phonosurgery.. 51 Key Points Selected Bibliography Anesthesia and Airway Management for Laryngeal Surgery Fundamental and Related Chapters Equipment Surgical Indications and Contraindications Principles of Airway Management: Subglottic and Tracheal Stenosis Special Circumstances: Difficult Exposure of the Larynx Anesthesia for Laryngeal Framework Surgery Key Points Selected Bibliography

12 Contents XIX Part B Phonomicrosurgery for Benign Laryngeal Pathology I Fundamentals of Phonomicrosurgery 10 Principles of Phonomicrosurgery Fundamental and Related Chapters Introduction Surgical Indications and Contraindications Equipment for Phonomicrosurgery Phonomicrosurgery Procedures, Techniques, and Methods Anesthesia Patient Position Laryngoscope Placement Suspension Device External Counter-Pressure Telescopic Evaluation of Vocal Fold Pathology Operating Microscope and Surgeon Ergonomics Microflap Approach to Submucosal Pathology Postoperative Care and Complications Key Points Selected Bibliography Perioperative Care for Phonomicrosurgery Fundamental and Related Chapters Timing of Phonomicrosurgery Surgical Indications and Contraindications Considerations for the Day of Phonomicrosurgery Postoperative Voice Rest Postoperative Voice Care Intralaryngeal Steroid Injection to Soften Postoperative Scar in the Vocal Fold Key Points Selected Bibliography Management and Prevention of Complications Related to Phonomicrosurgery Fundamental and Related Chapters Overview of Management and Prevention of Complications Related to Phonomicrosurgery Surgical Indications and Contraindications Postoperative Dysphonia Medical Complications Associated with Phonomicrosurgery Key Points Selected Bibliography Principles of Laser Microlaryngoscopy Fundamental and Related Chapters Laser Physics Wavelength Tissue Interaction Delivery Systems Types of Laser Surgical Indications and Contraindications Equipment: Laser Microlaryngoscopy Setup CO 2 Laser Safety Guidelines General Guidelines (Fig. 13.1) CO 2 Laser Settings Safety Protocol Surgical Principles Smoke Evacuation Protecting Surrounding Tissue from Laser Damage Maintenance of a Clean Surgical Field Complications and Their Treatments Laser Fire Tracheal Perforation Key Points Selected Bibliography Principles of Vocal Fold Augmentation Fundamental and Related Chapters Vocal Fold Augmentation: Advantages, Disadvantages, and Clinical Utility Surgical Indications and Contraindications Characteristics of Vocal Fold Augmentation Materials Overview Categories of Vocal Fold Augmentation Materials Description of Vocal Fold Augmentation Materials Characteristics General Principles of Vocal Fold Augmentation Key Points Selected Bibliography II Phonomicrosurgical Voice Procedures 15 Vocal Fold Polyp Fundamental and Related Chapters Disease Characteristics and Differential Diagnosis Surgical Indications and Contraindications Surgical Equipment Surgical Procedures Postoperative Care/Complications Key Points Selected Bibliography Vocal Fold Nodules Fundamental and Related Chapters Disease Characteristics and Differential Diagnosis Surgical Indications and Contraindications Surgical Equipment Surgical Procedure

13 XX Contents 16.6 Postoperative Care and Complications Key Points Selected Bibliography Vocal Fold Cyst and Vocal Fold Fibrous Mass Fundamental and Related Chapters Diagnostic Characteristics and Differential Diagnosis Surgical Indications and Contraindications Surgical Equipment Surgical Procedure Postoperative Care and Complications Key Points Selected Bibliography Polypoid Corditis Fundamental and Related Chapters Disease Characteristics Surgical Indications and Contraindications Surgical Equipment Surgical Procedure Postoperative Care and Complications Key Points Selected Bibliography Vocal Fold Granuloma Fundamental and Related Chapters Disease Characteristics and Differential Diagnosis Surgical Indications and Contraindications Surgical Equipment Surgical Procedure Postoperative Care and Complications Key Points Selected Bibliography Vocal Fold Leukoplakia and Hyperkeratosis Fundamental and Related Chapters Diagnostic Characteristics and Differential Diagnosis Surgical Indications and Contraindications Surgical Equipment Surgical Procedure Postoperative Care and Complications Key Points Selected Bibliography Surgical Treatment of Recurrent Respiratory Papillomatosis of the Larynx Fundamental and Related Chapters Disease Characteristics and Differential Diagnosis Surgical Indications and Contraindications Surgical Equipment Surgical Procedure Postoperative Care and Complications Key Points Selected Bibliography Surgical Management of Vocal Fold Vascular Lesions Fundamental and Related Chapters Diagnostic Characteristics and Differential Diagnosis of Vocal Fold Varicosities Surgical Indications and Contraindications Surgical Equipment Surgical Procedure Postoperative Care and Complications Key Points Selected Bibliography Vocal Fold Scar and Sulcus Vocalis Fundamental and Related Chapters Disease Characteristics and Differential Diagnosis Surgical Indications and Contraindications Surgical Equipment Surgical Procedure Postoperative Care and Complications Key Points Selected Bibliography Endoscopic Management of Teflon Granuloma Fundamental and Related Chapters Disease Characteristics and Differential Diagnosis Surgical Indications and Contraindications Surgical Equipment Surgical Procedure Postoperative Care and Complications Key Points Selected Bibliography Endoscopic Excision of Saccular Cyst Fundamental and Related Chapters Disease Characteristics and Differential Diagnosis Surgical Indications and Contraindications Surgical Equipment Surgical Procedure for Saccular Cyst Postoperative Care and Complications Key Points Selected Bibliography Anterior Glottic Web Fundamental and Related Chapters

14 Contents XXI 26.2 Disease Characteristics and Differential Diagnosis Surgical Indications and Contraindications Surgical Equipment Surgical Procedure Postoperative Care and Complications Key Points Selected Bibliography Disease Characteristics and Differential Diagnosis Surgical Indications and Contraindications Surgical Equipment Surgical Procedure Postoperative Care and Complications Key Points Selected Bibliography III Laser Microlaryngeal Surgery (Airway/Neoplastic Conditions) 27 Bilateral Vocal Fold Paralysis Fundamental and Related Chapters Disease Characteristics and Differential Diagnosis Surgical Indication and Contraindications Surgical Equipment Surgical Procedure Postoperative Care and Complications Key Points Selected Bibliography Posterior Glottic Stenosis: Endoscopic Approach Fundamental and Related Chapters Diagnostic Characteristics and Differential Diagnosis Surgical Indications and Contraindications Surgical Equipment Surgical Procedure Postoperative Care Key Points Selected Bibliography Subglottic/Tracheal Stenosis: Laser/ Endoscopic Management Fundamental and Related Chapters Disease Characteristics and Differential Diagnosis Surgical Indications and Contraindications Surgical Equipment Surgical Procedure Postoperative Care and Complications T-Tube Stenting of SGS Surgical Equipment Surgical Procedure Postoperative Care Special Considerations in T-Tube Stenting Key Points Selected Bibliography Carcinoma of the Vocal Fold Fundamental and Related Chapters IV Laryngeal Injection Techniques 31 Vocal Fold Augmentation via Direct Microlaryngoscopy Fundamental and Related Chapters Disease Characteristics Material Selection Surgical Indications and Contraindications Surgical Equipment Surgical Procedure Principles of Deep Vocal Fold Augmentation Vocal Fold Augmentation via Microlaryngoscopy Endoscopic Vocal Fold Injection Lipoinjection of the Vocal Fold Postoperative Care and Complications Key Points Selected Bibliography Superficial Vocal Fold Injection Fundamental and Related Chapters Disease Characteristics and Differential Diagnosis Surgical Indications and Contraindications Surgical Equipment Surgical Procedure Postoperative Care and Complications Key Points Selected Bibliography Peroral Vocal Fold Augmentation in the Clinic Setting Fundamental and Related Chapters Disease Characteristics and Differential Diagnosis Surgical Indications and Contraindications Suitability for Peroral Vocal Fold Augmentation in the Clinic Setting Surgical Equipment Surgical Procedure Postoperative Care and Complications Key Points Selected Bibliography

15 XXII Contents 34 Percutaneous Vocal Fold Augmentation in the Clinic Setting Fundamentals and Related Chapters Disease Characteristics and Differential Diagnosis Surgical Indications and Contraindications Suitability for Percutaneous Vocal Fold Augmentation in the Clinic Setting Surgical Equipment Surgical Procedure Postoperative Care and Complications Key Points Selected Bibliography Botulinum Toxin Injection of the Larynx Fundamental and Related Chapters Disease Characteristics and Differential Diagnosis Botulinum Toxin Fundamentals Spasmodic Dysphonia and Essential Tremor Different Botulinum Toxin Injection Approaches Surgical Indications and Contraindications Equipment Procedure Postprocedure Care and Complications Key Points Selected Bibliography Part C Laryngeal Framework Surgery 36 Principles of Laryngeal Framework Surgery Fundamental and Related Chapters Introduction Surgical Indications and Contraindications Medialization Laryngoplasty Arytenoid Adduction Cricothyroid Subluxation Patient Selection for Laryngeal Framework Surgery Timing of Medialization Laryngoplasty Technical Notes and Pertinent Anatomic Landmarks for Medialization Laryngoplasty 232 Key Points Selected Bibliography Perioperative Care for Laryngeal Framework Surgery Fundamental and Related Chapters Perioperative Issues in Laryngeal Framework Surgery Surgical Indications and Contraindications Suboptimal Results/Surgical Errors Revision Surgery Long-Term Surgical Issues Key Points Selected Bibliography Silastic Medialization Laryngoplasty for Unilateral Vocal Fold Paralysis Fundamental and Related Chapters Disease Characteristics and Differential Diagnosis Surgery Indications and Contraindications Surgical Equipment Surgical Procedure Postoperative Care and Complications Key Points Selected Bibliography GORE-TEX Medialization Laryngoplasty Fundamental and Related Chapters Disease Characteristics and Differential Diagnosis Surgical Indications and Contraindications Surgical Equipment Surgical Procedure Postoperative Care and Complications Key Points Selected Bibliography Arytenoid Adduction Fundamental and Related Chapters Fundamentals of Arytenoid Adduction Surgical Indications and Contraindications Surgical Equipment Surgical Procedure Postoperative Care and Complications Key Points Selected Bibliography Cricothyroid Subluxation Fundamental and Related Chapters Disease Characteristics and Differential Diagnosis Surgical Indications and Contraindications Surgical Equipment Surgical Procedure Postoperative Care and Complications Key Points Bibliography Translaryngeal Removal of Teflon Granuloma Fundamental and Related Chapters Disease Characteristics and Differential Diagnosis

16 Contents XXIII 42.3 Surgical Indications and Contraindications Surgical Equipment Surgical Procedure Postoperative Care and Complications Key Points Selected Bibliography Excision of Combined Laryngocele Fundamental and Related Chapters Disease Characteristics and Differential Diagnosis Anatomy and Classification Clinical Presentation and Differential Diagnosis Surgical Indications and Contraindications Surgical Equipment Surgical Procedure Postoperative Care and Complications Key Points Selected Bibliography Repair of Laryngeal Fracture Fundamental and Related Chapters Disease Characteristics Surgical Indications and Contraindications Surgical Equipment Surgical Procedure Postoperative Care and Complications Key Points Selected Bibliography Glottic and Subglottic Stenosis: Laryngotracheal Reconstruction with Grafting Fundamental and Related Chapters Disease Characteristics and Differential Diagnosis Surgical Indications and Contraindications Surgical Equipment Surgical Procedure Postoperative Care and Complications Key Points Selected Bibliography Glottic and Subglottic Stenosis: Cricotracheal Resection with Primary Anastomosis Fundamental and Related Chapters Diagnostic Characteristics for Open Treatment of Subglottic Stenosis Surgical Indications and Contraindications Surgical Equipment Surgical Procedure Postoperative Management Key Points Selected Bibliography Tracheal Stenosis: Tracheal Resection with Primary Anastomosis Fundamental and Related Chapters Background Information and Diagnosis of Tracheal Stenosis Surgical Indications and Contraindications Surgical Equipment Surgical Procedure Postoperative Care and Complications Key Points Selected Bibliography The Gray Minithyrotomy for Vocal Fold Scar/Sulcus Vocalis Fundamental and Related Chapters General Considerations Surgical Indications and Contraindications Surgical Equipment Surgical Procedure Postoperative Care and Complications Key Points Selected Bibliography Subject Index

17 Contributing Authors Milan Amin, M.D. Chief, Division of Laryngology Department of Otolaryngology New York University School of Medicine 550 First Avenue, NBV 5E5 New York, NY Chapter 2: Principles of Clinical Evaluation for Voice Disorders Chapter 45: Subglottis Stenosis: Laryngotracheal Reconstruction with Grafting Michiel J. Bové, M.D. Searle Building Room Superior Chicago, IL Chapter 2: Principles of Clinical Evaluation for Voice Disorders Mark Courey, M.D. UCSF Voice & Swallowing Center 2330 Post Street, 5th Floor San Francisco, CA Chapter 28: Posterior Glottis Stenosis Endoscopic Approach (Laser Division with MMC) Jonathan R. Grant, M.D. Dept. of Otolaryngology and Communication Sciences Medical College of Wisconsin Milwaukee, IL Chapter 34: Percutaneous VF Augmentation in a Clinical Setting Patrick J. Gullane, M.D Eaton Wing N Toronto General 200 Elizabeth Street, Room 3S438 Toronto, Ontario M5G 2CH Canada Chapter 46: Glottic and Subglottic Stenosic: Cricotracheal resection with primary anastamosis Rene Gupta, MD Department of Otolaryngology New York University School of Medicine 550 First Avenue, NBV 5E5 New York, NY Chapter 29: Subglottis Stenosis: Laryngotracheal Reconstruction with Grafting Michael Johns, M.D. Emory Health Care Dept. of Otolaryngology 550 Peachtree Street, Suite Atlanta, GA Chapter 1: Anatomy and Physiology of the Larynx Priya Krishna, M.D. University of Pittsburg Voice Center Department of Otolaryngology 200 Lothrop Street, Suite 500 Pittsburgh, PA Chapter 7: Medical Treatment of Voice Disorders

18 XXVI Invited Authors Albert Merati, M.D. University of Washington Department of Otolaryngology Box Health Sciences Building Suite BB1165 Seattle, WA Chapter 34: Percutaneous VF Augmentation in a Clinical Setting Chapter 47: Tracheal Resection with Primary Anastomosis Christine Novak PT Eaton Wing N Toronto General 200 Elizabeth Street, Room 3S438 Toronto, Ontario M5G 2CH Canada Chapter 46: Glottic and Subglottic Stenosic: Cricotracheal resection with primary anastamosis Gregory Postma, M.D. Department of Otolaryngology Medical College of Georgia th Street Augusta, GA Chapter 39: Goretex Medialization Laryngoplasty Anthony Rider, MD Department of Otolaryngology and Communication Sciences Medical College of Wisconsin Milwaukee, WI Chapter 47: Tracheal Resection with Primary Anastomosis Robert T. Sataloff, M.D Pine Street Philadelphia, PA Chapter 22: Vocal Fold Varix Lucian Sulica, M.D. 10 Union Square East, Suite 4J New York, NY Chapter 35: Botox Toxin Injection Chapter 37: Peri-Operative Care for Laryngeal Framework Surgery Chapter 38: Principles of Laryngeal Framework Surgery Chapter 48: Mini-Thyrotomy for Vocal Fold Scar